The document summarizes a study that evaluated the efficacy of a joint mobilization apparatus in treating frozen shoulder. The study involved 48 patients with frozen shoulder who were randomly assigned to either a control group receiving regular physical therapy or an experimental group receiving physical therapy plus treatment with the joint mobilization apparatus. Outcome measures including range of motion and pain were assessed at baseline and after 4 and 8 weeks of treatment. The results showed that the experimental group had significantly greater improvements in range of motion and reductions in pain levels compared to the control group receiving only physical therapy. The study concluded that the joint mobilization apparatus combined with physical therapy can further improve shoulder function and relieve pain in patients with frozen shoulder compared to physical therapy alone.
The document summarizes a systematic review that analyzed 15 randomized controlled trials on the use of acupuncture and related techniques for postoperative pain management. The review found that acupuncture was associated with significant reductions in postoperative opioid consumption, pain intensity, and opioid-related side effects such as nausea, dizziness, and sedation, compared to sham controls. Specifically, acupuncture reduced opioid use by 23-29 mg at 8-72 hours postoperatively and decreased pain scores at 8 and 72 hours. The studies involved a variety of surgeries and acupuncture methods.
Exergames for Patients in Acute Care Settings: Systematic Review of the Repor...Games for Health Europe
TRACK 7 (1)| SELF MANAGEMENT PART 2 | DAY 2 - 1 NOV 2016
Ruud Krols, Senior Researcher & physiotherapist | University Hospital Zurich (CH)
Games for Health Europe 2016
This study compared the effects of a clinical physical therapy program versus a home-based physical therapy program for female patients with knee osteoarthritis. The clinical program included manual therapy, supervised exercises, and electroacupuncture, while the home program included only exercises. Both programs improved knee function and reduced pain and stiffness, but the clinical program produced greater improvements in range of motion, pain reduction, and physical function compared to the home program. The study concluded that both programs were effective for osteoarthritis, but a clinical program provided better outcomes while a home program could still provide benefits and reduce costs.
Medical shockwaves for chronic low back pain - a case seriesKenneth Craig
This case series examines the use of medical shockwave therapy for 10 patients with chronic low back pain. Shockwave therapy involves using focused acoustic pulses to target deep tissue. After 3 sessions of 1000 pulses each over 3 weeks, 8 of the 9 patients showed excellent improvement in pain levels, functional disability, and reduced need for pain medication that was maintained at the 12 week follow up. This positive preliminary outcome supports further investigation of shockwave therapy as a potential disease-modifying treatment for chronic low back pain.
This study examined the effects of using the upper limb tension test (ULTT) as a neural mobilization technique in addition to conservative treatment for patients with cervical radiculopathy. 40 patients were divided into a control group receiving conservative treatment only and an experimental group receiving conservative treatment plus ULTT. Outcome measures of cervical range of motion and pain were assessed before and after treatment. The results showed significantly greater improvements in cervical flexion, extension, and side flexion ranges of motion as well as pain levels for the experimental group compared to the control group, indicating that ULTT provides additional benefits for managing symptoms of cervical radiculopathy.
better Rehabilitation through vibro-acoustic-therapy.pdfmichel582642
Sound vibrations and sound wave therapy and their positive effects on the human body have been extensively researched and sufficiently proven.
These studies on the subject of rehabilitation are intended to illustrate how broadly the spectrum of possible patient groups that could benefit from sound wave therapy can be defined. In addition, this form of therapy could be a so-called game changer for prevention.
Enjoy reading!
Michel Menzel
Founder of THERAPIEGOLD
www.therapiegold.de
Efficacy of classification-based_cft_in_nsclbpMeziat
Artigo (6) importante para a preparação para o curso de dor lombar crônica. "Eficácia da Terapia Cognitiva Funcional em pacientes com dor lombar crônica inespecífica: ensaio clínico randomizado controlado."
This study compared the effects of three exercise interventions on motor performance in patients with Parkinson's disease: LSVT1BIG therapy, Nordic walking, and unsupervised home exercises. Sixty patients were randomly assigned to one of the three groups. The LSVT1BIG group showed a significant mean improvement of 25.05 points on the UPDRS motor score, while the Nordic walking and home exercise groups showed little to no change or mild deterioration. LSVT1BIG therapy was also superior in tests of timed up-and-go and timed 10m walking. There were no significant differences between groups for quality of life. The results provide evidence that LSVT1BIG is an effective technique for improving motor function
IM PNS vs UC for Motor Impairment 2014_04_10Henry Wu
This randomized controlled trial compared peripheral nerve stimulation (PNS) to usual care for reducing hemiplegic shoulder pain after stroke. The study assessed whether PNS improved glenohumeral stability through enhancing motor recovery. Both PNS and usual care groups showed significant improvements over time in isometric shoulder strength, pain-free range of motion, and motor impairment measures, but there were no significant differences between the groups, suggesting PNS did not enhance motor recovery more than usual care.
This meta-analysis reviewed 16 randomized controlled trials comparing the effectiveness of motor control exercises (MCE) to other treatments for chronic or recurrent low back pain. The analysis found that MCE was superior to general exercise in reducing both disability in the short, intermediate, and long term, and pain in the short and intermediate term. MCE was also superior to minimal interventions like advice or placebo for both pain and disability outcomes at all time periods. Compared to spinal manual therapy, MCE demonstrated superior results for reducing disability but not pain. The studies varied in quality but provided evidence that MCE can better improve pain and disability for low back pain over the short to long term compared to other common treatments.
This document summarizes several sources on the use of kinesiology taping. The sources discuss research that has found kinesiology taping can reduce pain from contractions and lymphedema in breast cancer patients. Additional research discussed found that kinesiology taping can improve joint position sense after muscle fatigue and help recovery from occupational wrist disorders in physical therapists. One source discussed a study that found kinesiology taping decreased upper back pain in female sedentary workers with rounded shoulder posture. Another source described a randomized controlled trial that found a mixed kinesiology taping-compression technique reduced venous symptoms, pain, and clinical severity in postmenopausal women with chronic venous insufficiency.
Motivational Enhancement Therapy in Addition to Physical
Therapy Improves Motivational Factors and Treatment
Outcomes in People With Low Back Pain: A Randomized
Controlled Trial
Qigong is a system of techniques from Traditional Chinese Medicine to cultivate the flow of qi (vital energy) in the body for health purposes. It involves physical postures, breathing exercises, and meditation. Early forms date back thousands of years in China. While some preliminary studies show benefits for conditions like cancer, pain, and hypertension, many studies have inconclusive results due to small sample sizes and lack of controls. More research is still needed to fully understand qigong's health effects and identify best practices.
This document provides guidelines for osteopathic manipulative treatment (OMT) for patients with low back pain from the American Osteopathic Association (AOA). It conducted a systematic review and meta-analysis of randomized controlled trials on OMT for low back pain. The analysis found OMT significantly reduced low back pain compared to control groups, with an effect size greater than placebo. OMT was effective regardless of the type of control treatment, country where the trial was conducted, or length of follow-up. The AOA recommends Osteopathic physicians use OMT for patients with low back pain based on the evidence from these studies.
ZMPCZM016000.11.23 Electrotherapy for pain managementpainezeeman
This document summarizes research on the use of electrotherapy/electrical stimulation for pain management. It discusses two major theories for how electrotherapy relieves pain through gate control and opiate-mediated control. Research studies cited found electrotherapy effective at reducing pain and improving function for chronic musculoskeletal pain, low back pain, and post-operative knee pain. Meta-analyses showed significant decreases in pain from electrical nerve stimulation and reductions in analgesic consumption when using adequate stimulation parameters.
The study compared the effects of hollowing and bracing exercises on the cross-sectional areas of abdominal muscles in middle-aged women over six weeks. Magnetic resonance imaging scans before and after the exercises showed that bracing exercises significantly increased the areas of the left rectus abdominis, both internal and external obliques, while hollowing exercises significantly increased the areas of the left and right transversus abdominis and left rectus abdominis. Between the groups, bracing exercises led to greater increases in the right transversus abdominis, left internal oblique, and both external obliques. The study concluded that bracing exercises are more effective than hollowing exercises at activating the abdominal muscles.
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1-
Ice Hole for
Phishing
2-
SocialKlepto for
Social
3-
SmartphonePF and
Mactans
for Mobile
4-
Hping and
Yersinia for networks
5-
LCP and
Cain and Abel for
PasswordCracking
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Read the attached information.
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Answers available in ...
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Take this time to do your
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Eliminate
Reactivate
Eliminate
Reactivate
Eliminate
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.
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Presentation follows the timeline of the evolution of business.
·
Presentation provides information on the different stages of business evolution, including:
o
Feudalism
o
Mercantilism
o
Capitalism
o
Commerce
o
Property rights
o
The Industrial Revolution
·
Presentation consists of 10 to 15 slides appropriate for the speaker’s audience.
·
Speaker notes are included for each slide.
·
Title and APA reference slide are included.
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Select
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Write
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·
Indicate whether the selected air pollutants are considered primary or secondary pollutants. Explain why they are considered to be primary or secondary and discuss the sources of these pollutants.
·
Describe how the selected air pollutants affect the different layers of the atmosphere. In looking at this interaction, how do greenhouse gases influence Earth’s climate? Discuss how these air pollutants and greenhouse gases affect human, plant, and animal life.
·
Examine the selected water pollutants. Discuss the sources of these pollutants and indicate their effects on water resources and aquatic life.
·
Discuss the effect of poor water quality on humans and the environment. What are some solutions for reducing poor water quality?
Cite
at least two references.
Format
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planning and implementing
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Write a 2-3 page paper in which you do the following:
1. Describe the common health problems associated with
indoor and outdoor air pollution
in urban settings.
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3. Describe how you (as a Health Educator and consultant in this multi-disciplinary team), would assist the nurse to
plan and implement
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Financial and economic publications like the Wall Street Journal, the Economist, and industry-specific publications
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Research databases like ProQuest
Use the
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Details that align with your microeconomics topic
List of your sources
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Aging and Disability Worksheet
Part I
Identify 2 or 3 issues faced by the aging population.
1.
2.
3.
Answer the following questions in 100 to 200 words each
.
Provide citations for all
the
sources
you use
.
·
What is ageism? How does ageism influence the presence of diversity in society?
·
What is the
Age
Dis
criminitation in Employment
Act (AD
E
A)? How does the AD
E
A address issues for the aging population?
·
What is being done to address the issues you identified?
·
Is the number of aging population expected to rise in numbers or decrease?
·
What types of legislation may or may not be affected by the aging population?
·
How does poverty affect the aging population?
Part II
Answer the following questions in 100 to 200 words each
.
Provide citations for all
the
sources
you use
.
·
What does the ADA provide for people with disabilities?
·
How have people with disabilities been treated in the past?
·
How has the attitude toward people with disabilities changed over time?
·
What are some unique circumstances or issues encountered by people with disabilities?
·
What is being done to address those issues?
·
What types of legislation have been introduced to address issues faced by people with disabilities?
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AI: Artificial Intelligence
1
Reading response
Peter Dormer, “Craft and the Turing Test for Practical Thinking,” in The Challenge of Technology.
What is personal know-how? What is distributed knowledge?
How do they relate to the Turing test?
Give one example of your own how these concepts matter today to artists and makers, or better yet, in your own experience?
Journal homework
Keep a record (text and drawings) of events in daily life where human and machine intersect and interact. Fill at least two pages with your observations.
Mary Shelley, Frankenstein, or The Modern Prometheus, 1818
Boris Karloff in Frankenstein in 1931 directed by James Whale
Mary Shelley first published Frankenstein, or the Modern Prometheus 1818. the novel allegorizes the Romantic obsession with discovering the power or principle of life. Ideas about a life power were consistent with the scientific understanding of the day. Darwin himself spoke of an organizing “spirit of animation” in his Zoonomia; or, The Laws of Organic Life, in which he stated “the world itself might have been generated, rather than created.”
Dr. Frankenstein picked all the parts for his monster based on their beauty, but when it comes to life, the monster is unbearably ugly. “I had worked hard for nearly two years, for the sole purpose of infusing life into an inanimate body…the beauty of the dream vanished, and breathless horror and disgust filled my heart. Unable to endure the aspect of the being I had created, I rushed out of the room”.
4
Two definitions of AI:
“The use of computer programs and programming techniques to cast light on the principles of intelligence in general and human thought in particular.
--Margaret Boden
“The science of making machines do things that would require intelligence if done by humans.”
-Marvin Minsky
BOTH OF THESE STATEMENTS ORIGINATE IN ALAN TURING’S FIRST COMPUTER SCIENCE ARTICLE
Working assumption: all cognition is computable
Question:
Is what’s not yet known to be computable actually computable?
if so, then what?
if not, why not, and what does that tell us about cognition?
7
Who was Alan Turing?
B. 1912 London, attended King’s College, Cambridge and Princeton University. He studied mathematics and logic (he hadn’t invented computer science yet)
At 23, he invented the “Turing machine” and published “On Computable Numbers in 1936, the first and most important paper in comp. sci.
During WWII, solved the German Enigma code by use of electromechanical devices—a precursor to the computer
Laid the foundation for major subfields of comp sci: theory of computation, design of hardware and software, and the study of artificial intelligence
“The Imitation Game,”
aka
“The Turing Test”
In 1950, Turing posited a way to test machine intelligence: a person in a room before a screen. S/he would correspond with two agents and based on their responses, decide which was a machine and which was human. If the machine can pass fo.
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Your response should be at least 200 words in length. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations.
David, F. (2011). 1.
Strategic management: concepts & cases
(Custom Edition ed., pp. 72-74). New York: McGraw-Hill Irwin.
No Wiki, Dictionary.com or Plagiarism
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Reactions to an Impending Death Sentence
and
Ties That Bind
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.
Slide Presentation from a Doctoral Virtual Open House presented on June 30, 2024 by staff and faculty of Capitol Technology University
Covers degrees offered, program details, tuition, financial aid and the application process.
How to Install Theme in the Odoo 17 ERPCeline George
With Odoo, we can select from a wide selection of attractive themes. Many excellent ones are free to use, while some require payment. Putting an Odoo theme in the Odoo module directory on our server, downloading the theme, and then installing it is a simple process.
Views in Odoo - Advanced Views - Pivot View in Odoo 17Celine George
In Odoo, the pivot view is a graphical representation of data that allows users to analyze and summarize large datasets quickly. It's a powerful tool for generating insights from your business data.
The pivot view in Odoo is a valuable tool for analyzing and summarizing large datasets, helping you gain insights into your business operations.
Front Desk Management in the Odoo 17 ERPCeline George
Front desk officers are responsible for taking care of guests and customers. Their work mainly involves interacting with customers and business partners, either in person or through phone calls.
The Jewish Trinity : Sabbath,Shekinah and Sanctuary 4.pdfJackieSparrow3
we may assume that God created the cosmos to be his great temple, in which he rested after his creative work. Nevertheless, his special revelatory presence did not fill the entire earth yet, since it was his intention that his human vice-regent, whom he installed in the garden sanctuary, would extend worldwide the boundaries of that sanctuary and of God’s presence. Adam, of course, disobeyed this mandate, so that humanity no longer enjoyed God’s presence in the little localized garden. Consequently, the entire earth became infected with sin and idolatry in a way it had not been previously before the fall, while yet in its still imperfect newly created state. Therefore, the various expressions about God being unable to inhabit earthly structures are best understood, at least in part, by realizing that the old order and sanctuary have been tainted with sin and must be cleansed and recreated before God’s Shekinah presence, formerly limited to heaven and the holy of holies, can dwell universally throughout creation
Satta Matka Dpboss Kalyan Matka Results Kalyan ChartMohit Tripathi
SATTA MATKA DPBOSS KALYAN MATKA RESULTS KALYAN CHART KALYAN MATKA MATKA RESULT KALYAN MATKA TIPS SATTA MATKA MATKA COM MATKA PANA JODI TODAY BATTA SATKA MATKA PATTI JODI NUMBER MATKA RESULTS MATKA CHART MATKA JODI SATTA COM INDIA SATTA MATKA MATKA TIPS MATKA WAPKA ALL MATKA RESULT LIVE ONLINE MATKA RESULT KALYAN MATKA RESULT DPBOSS MATKA 143 MAIN MATKA KALYAN MATKA RESULTS KALYAN CHART
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Kalyan today kalyan trick kalyan trick today kalyan chart kalyan today free game kalyan today fix jodi kalyan today matka kalyan today open Kalyan jodi kalyan jodi trick today kalyan jodi trick kalyan jodi ajj ka.
Delegation Inheritance in Odoo 17 and Its Use CasesCeline George
There are 3 types of inheritance in odoo Classical, Extension, and Delegation. Delegation inheritance is used to sink other models to our custom model. And there is no change in the views. This slide will discuss delegation inheritance and its use cases in odoo 17.
Beyond the Advance Presentation for By the Book 9John Rodzvilla
In June 2020, L.L. McKinney, a Black author of young adult novels, began the #publishingpaidme hashtag to create a discussion on how the publishing industry treats Black authors: “what they’re paid. What the marketing is. How the books are treated. How one Black book not reaching its parameters casts a shadow on all Black books and all Black authors, and that’s not the same for our white counterparts.” (Grady 2020) McKinney’s call resulted in an online discussion across 65,000 tweets between authors of all races and the creation of a Google spreadsheet that collected information on over 2,000 titles.
While the conversation was originally meant to discuss the ethical value of book publishing, it became an economic assessment by authors of how publishers treated authors of color and women authors without a full analysis of the data collected. This paper would present the data collected from relevant tweets and the Google database to show not only the range of advances among participating authors split out by their race, gender, sexual orientation and the genre of their work, but also the publishers’ treatment of their titles in terms of deal announcements and pre-pub attention in industry publications. The paper is based on a multi-year project of cleaning and evaluating the collected data to assess what it reveals about the habits and strategies of American publishers in acquiring and promoting titles from a diverse group of authors across the literary, non-fiction, children’s, mystery, romance, and SFF genres.
2. factors of group and time was used
to compare the outcomes between the two groups at baseline
(before treatment), immediately
after treatment, 1-month follow-up, and 3-month follow-up. The
level of significance was set at
p � 0.05.
Results: Significantly better scores in the NRS and Aberdeen
LBP scale were found in the ex-
ercise plus EA group immediately after treatment and at 1-
month follow-up. Higher scores were
also seen at 3-month follow-up. No significant differences were
observed in spinal AROM and
isokinetic trunk concentric strength between the two groups at
any stage of follow-up.
Conclusions: This study provides additional data on the
potential role of EA in the treatment
of LBP, and indicates that the combination of EA and back
exercise might be an effective option
in the treatment of pain and disability associated with chronic
LBP.
479
INTRODUCTION
Low-back pain (LBP) is a major health andeconomic problem in
Western countries
(van Tulder et al., 1997). At any given time,
some 31 million people in the United States
have low-back pain (LBP; Jensen et al., 1994),
and one half of the working population in the
United States have back symptoms each year
(Vallfors, 1985). Other studies have put the an-
3. nual incidence in the United States as high as
70% (National Institute for Occupational Safety
and Health, 1997). In a local survey, 39% of
adults in Hong Kong reported that they had
had at least one episode of LBP since birth (Lau
et al., 1995), and a telephone survey reported
that the cumulative life prevalence and the 12-
month prevalence of LBP in the Hong Kong
1Department of Rehabilitation Sciences, The Hong Kong
Polytechnic University, Hung Hom, Hong Kong.
2Physiotherapy Department, the Kwong Wah Hospital, Hong
Kong.
3Jockey Club Rehabilitation Engineering Center, The Hong
Kong Polytechnic University, Hung Hom, Hong Kong.
population were 57% and 42%, respectively
(Leung et al., 1999). Although there are no doc-
umented figures on the number of days sick
leave and compensation costs related to LBP in
Hong Kong, 66.8% of LBP subjects reported
that their back pain was work-related (Leung
et al., 1999).
The effectiveness of therapeutic interven-
tions for the treatment of chronic LBP has not
been convincingly demonstrated (Frymoyer,
1988; Spitzer et al., 1987). Acupuncture is an-
ticipated as being a potentially useful treatment
strategy to complement traditional Western
medical management in alleviating the pain
and disability associated with chronic LBP.
There has been an increasing use of acupunc-
ture in pain management (Woollam and Jack-
4. son, 1998), and acupuncture is now available
as a treatment option in chronic pain clinics in
many countries (Woollam and Jackson, 1998).
Electro-acupuncture (EA) is based on conven-
tional acupuncture, with the additional appli-
cation of an electric pulse to meridians and
acupoints in order to strengthen the effect. This
method is generally used for analgesia and has
become increasingly popular since the 1970s
(Chan, 1974; Tsui et al., 2002). This modality of
acupuncture has the advantages of standard-
ized quantity and quality of stimulation by con-
trolling the input current amplitude and fre-
quency.
The reported efficacy of acupuncture for the
management of chronic LBP in randomized
controlled trials was reviewed (van Tulder et
al., 1997) and it was found that the hetero-
geneity and poor methodological quality of the
studies conducted made the validity of results
obtained less convincing than they initially ap-
peared. Although evidence of long-term pain
relief after manual acupuncture and EA in
chronic nociceptive (nonorganic) LBP com-
pared to placebo was demonstrated (Carlsson
et al., 2001), the effectiveness of EA in treatment
of other forms of chronic LBP remains unclear.
The effects of acupuncture and acupuncture
plus back exercise have been compared (Song,
1993). However, the outcome measure was not
properly controlled because the therapeutic ef-
fect was rated subjectively as cured, markedly
effective, improved, and ineffective according
to the degree of alleviation of sign and symp-
5. tom (Song, 1993). Therefore, a well-designed
randomized control trial with a larger sample
size, valid acupuncture treatment, and out-
come measures is needed to determine the ef-
fectiveness of EA in the management of chronic
LBP. For ethical reasons, it was not feasible to
include an untreated control in this study, and
back exercise is used as is typically adminis-
tered by physiotherapists, either alone or in
combination with other methods of treatment
for chronic LBP. No attempt is made to com-
pare the efficacy of EA to more active ap-
proaches to treating chronic LBP patients (Kose
et al., 1995; Torstensen et al., 1998). Conse-
quently, the present randomized, assessor-
blinded controlled clinical trial is designed to
investigate the immediate and medium-term
effects of back exercises alone (control group)
or in conjunction with a series of EA treatment
(experimental group) on the pain, disability
and functional scores in patients with chronic
LBP.
MATERIALS AND METHODS
Patients with chronic LBP satisfying the in-
clusion and exclusion criteria listed in Table 1
were recruited through referral from the med-
ical officer in charge of the outpatient clinic of
the Department of Orthopaedics and Trauma-
tology, Kwong Wah Hospital, Hong Kong, dur-
ing the period 2001–2002. As a detailed specific
Western diagnosis cannot be made in the ma-
jority of patients with chronic LBP (Deyo and
Phillips, 1996; Waddell et al., 1996), subjects in-
cluded in this study were those with nonspe-
6. cific back pain without any underlying patho-
physiologic or anatomic problems identified
during physical and radiologic examination
(Hadler, 1993). Inclusion, exclusion, and with-
drawal criteria are listed in Table 1. Patients ful-
filling these criteria were asked to participate
in the study, and the aims and procedure of the
study were explained before written consent
was obtained. Ethical approval from the Ethics
Committee of the Hong Kong Hospital Au-
thority and the Human Subject Ethics Sub-
committee of The Hong Kong Polytechnic Uni-
versity was obtained prior to the start of the
study. Blocked randomization of patients to ei-
YEUNG ET AL.480
ther the exercise group (n � 26) or the exercise
plus EA group (n � 26) was used in this study
to minimize possible selection bias. Allocation
of patients to the two groups was randomized
and blinded, and patients were asked not to un-
dergo any other types of therapy for LBP dur-
ing the study period to avoid contamination of
the results.
Treatment procedure
Back exercise group. Patients received physio-
therapy in the form of a standard group exer-
cise program led by the same physiotherapist.
The program consisted of an hourly session
each week for 4 consecutive weeks, and com-
prised the following back strengthening and
7. stretching exercises:
• Warm up and stretching of back muscles �
10 minutes;
• Back extension exercise � 15 repetitions � 3
times with rest between (progress with
adding arm weight);
• Abdominal exercise � 15 repetitions � 3
times with rest between (progress by repo-
sitioning the arms); and
• Cool down with stretching of back muscles �
10 minutes.
In addition, patients were advised on spinal
anatomy and body mechanics, back care and
postural correction, lifting and ergonomic ad-
vice, and behavioral modification, as well as a
series of home exercises (15 minutes per day).
Patients were instructed to perform the desig-
nated types of back exercise every day over the
period of the study. Home exercise monitoring
cards were given to patients for recording pur-
poses, and an independent assessor checked
the patient’s compliance using these cards.
Back exercise plus EA group. The group exer-
cise program was conducted by a blinded ther-
apist in the same way as for the exercise group.
In addition, EA was administered three times
per week for 4 weeks by another physiothera-
pist certificated in acupuncture. The acupoints
were chosen according to a summation of com-
8. mon points used in the literature reviewed
along the Bladder and Spleen meridian (Coan
et al., 1980; Edelist et al., 1976; Gunn et al., 1980;
Lehmann et al., 1986; MacDonald et al., 1983;
Thomas et al., 1994). These were the UB23
(Shenshu), UB25 (Dachangshu), UB40 (Weiz-
hong), and SP 6 (Sanyinjiao) points (Fig. 1).
Acupuncture was applied to the side on which
patients reported pain. If the reported pain was
bilateral, EA was applied to the more painful
side. The patient was placed in a prone posi-
tion and a sterilized disposable number 30 (0.3-
mm diameter) 40-mm long needle was inserted
and manipulated until a sensation of numb-
ELECTRO-ACUPUNCTURE ON CHRONIC LOW-BACK PAIN
481
TABLE 1. INCLUSION, EXCLUSION AND WITHDRAWAL
CRITERIA
Inclusion criteria
1. Chronic LBP
It was defined as a complaint of pain of the lower back below
the
12th thoracic vertebrae with or without radiation with an onset
of
duration of 6 months or more
2. Age between 18–75 and of both genders
Exclusion criteria
1. Structural deformity (ankylosing spondylitis, scoliosis)
2. Lower limb fracture
3. Tumors
9. 4. Spinal infection
5. Cauda equina syndrome
6. Pregnancy
7. Spinal cord compression
8. Subjects who were inability to keep the appointments
9. Receiving acupuncture treatment within the past 6 months
10. Receiving physiotherapy treatment within the past 3 months
Withdrawal criteria
1. Other acute orthopaedic or medical problems that hinder back
exercise
LBP, lower back pain.
ness, tingling, heat, or distension at the site of
needle insertion, known as te chi in Chinese
Traditional Medicine, was obtained. The nee-
dle was then coupled to an electrical stimula-
tor (Shanghai Medical Technology Co., Shang-
hai) at a frequency of 2 Hz as suggested by
Han et al. (1981) for 30 minutes to allow en-
dorphinergic analgesia to build up (Gabriel et
al., 1985). The intensity of the stimulation was
set at the level that the patient could tolerate
and often with evoked visible muscle con-
tractions. We applied the current with bipha-
sic waveform (positive wave in the square
form and negative wave in the triangle form
with 0.5-ms pulse width) to the four selected
acupoints in two pairs (i.e., UB-23/UB-25 pair
and UB40/SP6 pair).
Collected data and outcome measures. All pa-
10. tients were assessed by a blinded observer who
was not aware of the treatment allocation. The
assessment was performed before and after the
treatment series as well as at 1 and 3 months
after the treatment. In this study, the primary
outcome measures were:
(1) Pain—Numerical rating scale (NRS) was
used to measure the average and the worst
pain intensity during the last week on as-
sessment, by asking the patient to rate his
or her perceived level of pain intensity on
a numerical scale from 0 to 10, with 0 rep-
resenting one extreme (no pain) and 10 rep-
resenting other extreme (pain as bad as it
could be). This shows a high reliability in
both literate and illiterate patients (Ferraz
et al., 1990), and it has also been demon-
strated that the NRS and visual analog
scales (VAS) have correlation ranging from
r � 0.77 to 0.91 (Downie et al., 1978).
(2) Disability—The Aberdeen LBP scale was
used to measure low back disability, be-
cause it is the only LBP-specific functional
disability scale that has been validated for
use in Chinese subjects. It consists of a 19-
item questionnaire that has been adapted
to be appropriate for Chinese culture, and
has a reported test-retest reliability of r �
0.94 (p � 0.05) with Cronbach � equal to
0.85. The correlation with the current
generic 42-item questionnaire is 0.59. It as-
sesses the health status of patients with LBP
across several dimensions, including pain,
11. physical impairments, and functional dis-
ability. Responses to the questions were
summed and converted to a score percent-
age between 0 and 100, with 0 representing
the least disabled and 100 the most severely
disabled (Leung et al., 1999).
Secondary outcome measures used in this
study were:
(1) Lumbar spinal angular range of motion (ROM)
in flexion-extension—The angular ROM of
the lumbar spine was measured using a
Dualer Plus inclinometer (Jtech Medical In-
dustries, Salt Lake City, UT). A pilot study
showed the inclinometer to give reliable
measurements, with intraclass correlation
coefficients (ICC) model (1,1) of 0.90 for
trunk flexion and 0.80 for extension. The
device was secured to the patient at the
sacrum and the thoracolumbar junction.
YEUNG ET AL.482
FIG. 1. The four acupoints, UB-23 (Shenshu), UB25
(Dachangshu), UB-40 (Weizhong), and SP-6 (Sanyinjiao),
used in the study.
Each exercise was demonstrated by the in-
vestigator and then practiced by the pa-
tients. Two trials of flexion-extension were
then carried out. The highest value gener-
ated was taken as representative for that
movement.
12. (2) The isokinetic trunk flexor and extensor
strength—The isokinetic trunk flexor and
extensor strength were measured using a
Cybex 6000TEF modular component isoki-
netic dynamometer (Lumex, Inc.,
Ronkonkoma, NY). Patients were mea-
sured standing with positioning standard-
ized according to the manufacturer’s rec-
ommendations. The axis of rotation was
centered approximately at the intersection
of the mid-axillary line and L5-S1, and the
angular ROM was set at 5-degree extension
and 60-degree flexion in all patients. Mea-
surements were at an angular velocity of 60
degrees per second because this closely ap-
proximates to a number of daily activities
(Motulsky, 1995). Five trial repetitions pre-
ceded measurements, where the same ex-
aminer asked the patient to move or pull
“as hard and as fast as they could.” Flexor
peak torque percent body weight (FPTBW),
extensor peak torque percent body weight
(EPTBW), flexor total work percent body
weight (FTWBW), and extensor total work
percent body weight (ETWBW) at 60° per
second were then measured over the fol-
lowing five repetitions.
Follow-up. Assessment was performed before
(as baseline) and immediately after the treat-
ment series. Follow-up assessment was at 1 and
3 months after the treatment series. The pa-
tients were reminded by either telephone or
mail. Exercise level, analgesic consumption,
and whether they had undertaken any other
13. therapy for their LBP during the study were
recorded, and all patients were also given a de-
tailed self-administered questionnaire on their
demographic information.
Statistical methods. Statistical analysis was
conducted based on the intention-to-treat prin-
ciple. Patients dropping out for reasons other
than the treatment to which they had been ran-
domly assigned were given the baseline regis-
tration scores for the missing timepoints. Pa-
tients dropping out because of the treatment to
which they were randomly assigned were
given the worst score registration (Torstensen
et al., 1998). To determine the robustness of
conclusions, the analysis was repeated when
missing data were discarded (Motulsky, 1995).
The former analysis (intention to treat) may
make it harder to find significant differences,
while the latter analysis (discarding missing
data) may make it easier to find significant dif-
ferences. Comparison of the demographic
characteristics and other variables of the two
groups at baseline were using the �2 test and t
test according to whether the variables under
consideration were categorical or continuous,
respectively. The mean was used as an index
of localization, and standard deviation as index
of dispersion. Changes in NRS, Aberdeen LBP
scale, spinal angular ROM in flexion-extension
and reciprocal isokinetic trunk concentric
flexor and extensor strength for the two groups
immediately after the treatment series, at 1-
month follow up and at 3-month follow up
were assessed using a two-factor (group �
14. ELECTRO-ACUPUNCTURE ON CHRONIC LOW-BACK PAIN
483
FIG. 2. Flow diagram describing the patients during the
study period. OPD, outpatient department; EA, electro-
acupuncture.
time of assessment) mixed repeated measures
analysis of variance (R-ANOVA). Differences
in the response over time between the two
groups were indicated by a significant interac-
tion. The level of significance was set at p �
0.05 in all comparisons. Analyses were per-
formed using SPSS for Windows statistical soft-
ware (version 10.0, SPSS, Inc., Chicago, IL).
RESULTS
Fifty-two (52) patients were entered to the
study over a period of 12 months. None of them
had undergone any back surgery before, and
all subjects completed the treatment sessions.
Three patients dropped out during the follow-
up period. Two were in the back exercise group
and defaulted at post-1–month follow-up be-
cause of lack of time to come for reassessment,
and one patient in the back exercise plus EA
group suffered from stroke before 3-month fol-
low-up (Fig. 2).
Sociodemographic characteristics
15. Admission data for the patients are summa-
rized in Table 2. There were no statistically sig-
nificant differences between the two groups in
terms of age, gender, body height, body
weight, duration of symptoms, diagnosis,
symptom radiation, and other treatment pro-
YEUNG ET AL.484
TABLE 2. BASELINE CHARACTERISTIC OF THE SUBJECTS
p value (group
Baseline characteristics n % n % difference)
Age (mean; SD) 55.6; 10.4 years 50.4; 16.3 years 0.177a
Body height (mean; SD) 155.8; 7.0 cm 155.5; 7.8 cm 0.867a
Body weight (mean; SD) 59.1; 7.96 kg 61.72; 10.78 kg 0.324a
Gender
Male 5 19.2% 4 15.4% 0.714b
Female 21 80.8% 22 84.6%
Duration of symptoms
6 month 4 15.4% 2 7.7% 0.665b
7–12 months 2 7.7% 5 19.2%
13–18 months 2 7.7% 3 11.5%
19–24 months 3 11.5% 2 7.7%
� 25 months 15 57.7% 14 53.8%
Presence of prolapsed
intervertebral disc
No 23 88% 26 100.%
Yes 3 12% 0 0.% 0.074b
Radiation
No 12 46.2% 12 46.2%
16. Yes 14 53.8% 14 53.8% 1.00b
Analgesic consumption
No 26 100.% 25 96.2%
Yes 0 0.% 1 3.8% 0.313b
Exercise level
No 10 26.9% 7 38.5%
Yes 16 73.1% 19 61.5% 0.375b
Receive other forms of treatment
No 20 76.9% 21 80.8%
Yes 6 23.1% 5 19.2% 0.734b
aIndependent T test.
b�2 test.
Radiation: complain of pain below the buttock level.
Analgesic consumption: no (not taken any analgesic); Yes
(taken analgesic regularly or when necessary).
Exercise level: no (not perform exercise once per week); yes
(perform exercise at least once per week).
Other forms of treatment: including Tui Na, massage,
chiropactor, bone setter, using corset, or other treatment on
the back.
EA, electro-acupuncture; SD, standard deviation.
Exercise group
(n � 26)
Exercise plus EA
group (n � 26)
grams prior to intervention. Blinded assess-
17. ment showed that compliance with the back
exercise program was equally good in both
groups. No patient received any other type of
therapy for back pain during the study period,
and all patients tolerated EA well without ad-
verse effects.
Outcomes
There were no significant differences be-
tween two groups with respect to analgesic
consumption and exercise level before, post-
treatment, post-1–month and 3-month follow
up (Table 3). Although there were no statisti-
cally significant differences between the two
groups at baseline, factors such as analgesic
consumption and the presence of prolapsed in-
tervertebral disc could confound the results,
and outcomes were analyzed while controlling
these two factors as covariates.
(1) Pain—On the NRS average pain score mea-
sure, interaction between group and time
of analysis was significant (p � 0.001). Sep-
arate analysis of covariance (ANCOVA)
was therefore performed to detect the dif-
ference between groups at any given time.
The mean score was lower in the exercise
plus EA group compared with the exercise
group alone. There was a significant re-
duction in the average pain score between
baseline and each of the follow-up assess-
ments such as post-treatment (p � 0.032, 1-
month follow-up (p � 0.030), and 3-month
follow-up (p � 0.005) (Table 4).
18. For the worst pain score, interaction be-
tween group and time of analysis was sig-
nificant (p � 0.005). Separate ANCOVA was
performed to detect the difference between
groups at any given time. The mean score
was lower in the exercise plus EA group as
compared with the exercise group alone.
There was a significant reduction in the
worst pain score at post-treatment (p �
0.026), to 1-month follow-up (p � 0.018) and
3-month follow-up (p � 0.001) (Table 4).
(2) Disability—On the Aberdeen LBP scale, in-
teraction between group and time of analy-
sis was significant (p � 0.001). Separate
ANCOVA was therefore performed to ex-
amine the difference between groups at any
given time. The mean score was lower in
the exercise plus EA group compared to the
exercise group alone. There was a signifi-
cant reduction in the Aberdeen LBP scale
post-treatment (p � 0.002), to 1-month fol-
low-up (p � 0.003), and 3-month follow-up
(p � 0.001) (Table 4).
(3) Isokinetic muscle strength—For the EPTBW
60° per second, the mean score was higher
in the exercise plus EA group compared to
exercise group alone at post-treatment to
1-month follow-up and 3-month follow-up,
however, it was not significant (p � 0.20).
It only demonstrated a significant differ-
ence between the various time periods
ELECTRO-ACUPUNCTURE ON CHRONIC LOW-BACK PAIN
19. 485
TABLE 3. ANALGESIC CONSUMPTION AND REGULAR
EXERCISE PERFORMED BEFORE, POST-TREATMENT,
POST-ONE–MONTH FOLLOW-UP AND POST-THREE–
MONTHS FOLLOW-UP
Exercise plus EA p value
Exercise group group (group
n � 26 n � 26 difference)
Analgesic consumption
No/Yes Pre 26/0 25/1 0.313
Post 24/2 20/6 0.124
Post-1–month 24/2 23/4 0.385
Post-3–months 22/4 24/2 0.385
Exercise level
No/Yes Pre 10/16 7/19 0.375
Post 8/18 3/23 0.090
Post-1–month 7/19 3/23 0.159
Post-3–months 7/19 3/23 0.159
�2 test used.
EA, electro-acupuncture.
within the subject group (p � 0.000)
(Table 4).
For the FPTBW 60° per second, the mean
score was higher in the exercise plus EA
20. group compared to the exercise group
alone at post-treatment to 1-month follow-
up and 3-month follow-up. It only demon-
strated a significant difference between the
various time periods within the subject
group (p � 0.000) but no significant differ-
ence was found between the two groups
(p � 0.454) (Table 3).
For the ETWBW 60 degrees per second,
the mean score was higher in the exercise
plus EA group compared to exercise group
alone at post-treatment to 1-month follow-
up and 3-month follow-up. No significant
differences within (p � 0.119) and between
the two groups (p � 0.125) was found at
any of the follow up periods (Table 4).
For the FTWBW 60 degrees per second,
the mean score was higher in the exercise
plus EA group compared to exercise group
alone at post-treatment to 1-month and 3-
YEUNG ET AL.486
TABLE 4. CHANGES IN PAIN, DISABILITY, SPINAL AROM,
AND ISOKINETIC MUSCLE STRENGTH, BEFORE,
POST-TREATMENT, POST-ONE–MONTH FOLLOW-UP AND
POST-THREE–MONTH FOLLOW-UP
Exercise plus EA p value
Exercise group group (excluding
mean (SD) mean (SD) missing
Outcome variables Duration n � 26 n � 26 p value Power data)
22. Post-1–month 101.88 (80.06) 134.08 (84.28)
Post-3–month 108.46 (95.35) 143.85 (74.93)
FPTBW 60 degree/ Pre 127.19 (79.16) 127.42 (63.28) 0.454
11% 0.663
sec (nm) Post 125.73 (76.81) 156.54 (62.35)
Post-1–month 132.54 (78.67) 165.19 (67.96)
Post-3–month 183.19 (141.69) 212.58 (94.38)
ETWBW 60 degree/ Pre 68.77 (65.44) 92.92 (61.16) 0.125 34%
0.194
sec (J) Post 91.77 (73.47) 121.04 (47.29)
Post-1–month 92.85 (78.61) 129.42 (69.89)
Post-3–month 79.38 (79.15) 136.31 (185.53)
FTWBW 60 degree/ Pre 117.23 (102.70) 138.42 (84.12) 0.204
25% 0.623
sec (J) Post 113.27 (93.15) 161.27 (75.77)
Post-1–month 120.38 (101.26) 169.35 (83.49)
Post-3–month 145.08 (128.93) 179.54 (84.02)
*p � 0.05.
AROM, angular range of motion; EA, electro-acupuncture;
EPTBW, extensor peak-torque percent body weight;
FPTBW, flexor peak torque percent body weight; NRS,
numerical rating scale; LBP, low back pain.
month follow-up. A significant difference
between the various time periods was
found within the subject group (p � 0.008)
23. but no significant difference between the
two groups was found (p � 0.204) (Table 4).
(4) Spinal angular ROM—For the angular ROM
in flexion and extension, the mean of the
exercise plus EA group was better than the
exercise group alone at post-treatment to 1-
month and 3-month follow-up. A signifi-
cant difference between the various time
periods within the subject group was seen
(flexion: p � 0.001 and extension: p � 0.001)
but no significant difference was found be-
tween the two groups (flexion: p � 0.099
and extension: p � 0.098) (Table 4). The
analyses were repeated when all missing
data were discarded. All conclusions were
essentially identical between two groups,
however, final conclusions were drawn
from the intention-to-treat analysis.
DISCUSSION
The aim of this study is to determine if EA
is an effective and safe treatment option that
can reduce pain, decrease disability, and im-
prove functional capacity of patients with
chronic LBP. No adverse reaction to or com-
plications arising from EA were found in this
study. In this randomized trial, there was a sig-
nificant reduction of pain and disability in the
exercise plus EA group. While the results of
spinal angular ROM and reciprocal isokinetic
trunk measurement showed the mean changes
to be superior in the exercise plus EA group at
all time points, these differences did not reach
statistical significance between the two groups.
24. These results support the growing body of
literature that there is often little correlation
among actual functional impairment (such as
lumbar motion and muscle strength), disabil-
ity and the self-assessment of pain (Hazard et
al., 1994; Waddell, 1992). All of these physical
measures are affected by patient’s motivation,
effort, and psychological state (Deyo, 1988). It
has been concluded that these measures are
poor at predicting long-term outcome, includ-
ing return to full normal activity (Deyo, 1988).
The results of these studies show that changes
in these outcome measures were not always re-
lated to the changes in patient’s ability to per-
form functional tasks. This demonstrates the
importance of considering the multiplicity of
factors that define the function and disability
indexes of those suffering from chronic LBP.
Because of this, many authors are now ques-
tioning the exclusive use of impairment mea-
sures to determine the outcome treatment
(Deyo et al., 1994; Jette, 1995; Waddell, 1987).
Therefore the impairment outcomes are only
considered as secondary outcomes in the pres-
ent study. The results of angular ROM in the
current study were consistent with the finding
of Edelist et al. (1976). One possible reason for
lack of significant change in angular ROM may
be because of the high baseline values found in
this study, as most of the patients were able to
reach below the knee in flexion and behind the
thigh in extension. Another possible reason for
the lack of significant change was the low
power, ranging from 11% to 38% of these pa-
25. rameters (Table 4). A larger sample size may
be needed to detect significant changes.
Different outcome measures probably mea-
sure different entities, and therefore to get a
fuller picture of the intervention a combination
of relevant outcome measures should be used
(Delitto, 1994; Deyo et al., 1988; Jette, 1994). The
current study takes this into account by using
the Aberdeen LBP scale to evaluate the pa-
tient’s progress after treatment. This disease-
specific questionnaire is a simple clinical tool
and contained questions adapted for Chinese
subjects, giving a high level of reliability and
validity (Leung et al., 1999). Use of a self-re-
ported disease-specific questionnaire to assess
a patient’s level of function or disability in
chronic LBP has been highly recommended
(Paul and Christopher, 1997). As such, the Ab-
erdeen LBP scale was used in combination with
NRS as the primary outcome measure. Analy-
sis after discarding the missing data or on the
basis of an intention-to-treat analysis did not
result in any significant changes in the results.
Powers ranging from 69% to 89% were ob-
tained for all of the primary outcome measures
(Table 3), indicating a strong confidence in the
short and medium-term pain relieving effect
(NRS) and decrease in disability (Aberdeen
LBP scale) in the exercise plus EA group com-
ELECTRO-ACUPUNCTURE ON CHRONIC LOW-BACK PAIN
487
26. pared to back exercise alone. This outcome has
been suggested by previous literature (Coan et
al., 1980; Lehmann et al., 1986; MacDonald et
al., 1983; Spitzer et al., 1987), but has been lim-
ited by unclear outcome measures and incon-
sistent effects.
The mechanism of EA might be explained by
the findings that EA could accelerate the re-
lease of opioid peptides from the central ner-
vous system (Han and Wang, 1992). An animal
study also showed that repeated EA stimula-
tion has cumulative therapeutic effect on
chronic pain and suggested that EA analgesia
and morphine analgesia share similar mecha-
nism (Wang et al., 1992). Furthermore, Han et
al. (1990) demonstrated that different frequen-
cies of stimulation can facilitate differential re-
lease of different brain neuropeptides.
According to Traditional Chinese Medicine,
chronic LBP is primarily because of deficiency
in the kidney, and the treatment principle is
therefore to reinforce the kidney and strengthen
the bones. Unlike previous studies, which used
a number of acupoints varying between sub-
jects (Coan et al., 1980; Edelist et al., 1976; Gunn
et al., 1980; Lehmann et al., 1986; MacDonald
et al., 1983; Thomas et al., 1994), the current
study only uses four acupoints: UB23 (Shen-
shu), UB25 (Dachangshu), UB40 (Weizhong), and
SP 6 (Sanyinjiao), to reinforce the kidney qi,
dredge the meridians, and activate the collat-
eral (George et al., 1998). The use of these four
acupoints resulted in reduced pain and dis-
ability, and as some patients have a fear of nee-
27. dle pain, avoiding excessive use of acupoints
may be of benefit.
Limitations
There are a few limitations evident in this
study. Concerns about subjects’ long-term fol-
low-up rate, meant that the follow-up period
of the current study was 3 months after termi-
nation of the treatment series. Therefore, only
the immediate and medium-term effects were
demonstrated, but the long-term benefits of EA
were not examined in this study.
An additional concern regards the lack of
placebo or sham acupuncture control group in
this clinical trial, in that there was no control
for the additional time and attention in the EA
group plus exercise group. It is not known
whether the advantage found for this group is
the result of the EA or to nonspecific treatment
effects associated with these 12 sessions such
as patient expectations or attention from the
therapist. As such, it is impossible to prove
whether EA was an important part of the treat-
ment method or whether the improvement felt
by the patients in the exercise plus EA group
was due to the therapeutic setting and psy-
chological phenomena (Lewith and Machin,
1983; Richardson and Vincent, 1986; Vincent et
al., 1995). However, the interaction between pa-
tient and acupuncturist was minimized to ex-
clude potential bias. No additional intervention
was included, and conversation was limited to
a short explanation about the procedure at each
28. treatment session. Outcome evaluation was
performed by a blinded assessor and self-re-
ported questionnaire. While it has been argued
that approximately 20%–30% improvement in
short-term pain relief might be expected as a
result of the placebo effect of acupuncture
alone (Richardson et al., 1986), the present
study showed approximately 40% to 45% im-
provement, indicating that EA is likely to
demonstrate some analgesic effect apart from
placebo. Nevertheless, further studies are re-
quired to add weight to the conclusion that EA
has specific therapeutic effect beyond nonspe-
cific placebo effects.
Both groups used a standardized back exer-
cise program, and no studies have been per-
formed to demonstrate the validity and signif-
icance of this program. Because the program
involves both the flexion and extension exer-
cise of the back, the therapist would ask pa-
tients for any increase in pain intensity after
each exercise session to ensure that the exercise
program was not resulting in increased pain
and disability.
CONCLUSIONS
Despite the limitations of this clinical trial,
the randomized clinical trial setting made it
possible to control for cofounders such as age,
gender, duration of pain, and selection bias.
These controls, together with the comparably
homogeneous patient group, blinded random-
YEUNG ET AL.488
29. ization procedure, standardized treatment and
data collection procedure, low dropout rate
(5.77%), blinded assessment, and data analysis
using the intention-to-treat principle and dis-
carding incomplete data sets all add to the re-
liability of this study. Positive effects of EA
compared to back exercise group alone were
demonstrated in a number of outcome mea-
sures including pain relief and functional ca-
pacities on disability level. This benefit was
maintained at 3-months follow-up. It is con-
cluded that EA has an additional value to stan-
dard back exercise, and may be an effective op-
tion in the treatment of pain and disability
associated with chronic LBP. This study pro-
vides additional data on the potential role of
EA in the treatment of chronic LBP.
Most of the previous studies in EA were lack-
ing in methodological design and consequently
the results produced are less than convincing.
There is an urgent need for further well-
designed clinical trials in this area. A well-
designed, double-blinded, randomized study
with larger sample size and a sham control
group is recommended to examine both the
short- and long-term effects of EA and to pro-
vide more definitive evidence of its effectiveness
or otherwise in the management of chronic LBP.
ACKNOWLEDGMENTS
We acknowledge The Hong Kong Polytechnic
30. University Area of Strategy Development Fund
(A106) and Tung Wah Board Fund for support-
ing this study. The authors also thank the pa-
tients and staff of the Physiotherapy Department
of the Kwong Wah Hospital, Hong Kong, for
their participation, particularly L. Fung, M.Sc.,
C. Li, M.Sc., S. Cheung, M.Sc., S. Lo, M.Sc., W.
Luk, M.Sc., and R. Wong, M.Sc. We would also
like to express appreciation for Mr. J. Yeung
for his participation in the collection of data and
Andrew Holmes, Ph.D., for the editing.
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Address reprint requests to:
Mason C.P. Leung, Ph.D.
Department of Rehabilitation Sciences
The Hong Kong Polytechnic University
36. Hung Hom, Hong Kong
E-mail: [email protected]
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